Symptoms of Selective Mutism

Selective mutism is a rare type of anxiety disorder whose main distinguishing characteristic is the persistent failure to speak in specific social situations (e.g., at school, or with playmates) where speaking is expected, despite speaking in other situations.

Selective mutism interferes with educational or occupational achievement or with social communication, and in order for it to be diagnosed, it must last for at least 1 month and is not limited to the first month of school (during which many children may be shy and reluctant to speak).

Selective mutism should not be diagnosed if the individual’s failure to speak is due solely to a lack of knowledge of, or comfort with, the spoken language required in the social situation. It is also not diagnosed if the disturbance is better accounted for by embarrassment related to having
a Communication Disorder (e.g., Stuttering) or if it occurs exclusively during a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. Instead of communicating by standard verbalization, children with this disorder may communicate by gestures, monosyllabic, short, or monotone utterances, or in an altered voice.

Associated Features

Associated features of Selective Mutism may include excessive shyness, fear of social embarrassment, social isolation and withdrawal, clinging, compulsive traits, negativism, temper tantrums, or controlling or oppositional behavior, particularly at home. There may be severe impairment in social and school functioning. Teasing or scapegoating by peers is common. Although children with this disorder generally have normal language skills, there may occasionally be an associated Communication Disorder (e.g., Phonological Disorder, Expressive Language Disorder, or Mixed Receptive-Expressive Language Disorder) or a general medical condition that causes abnormalities of articulation.

Anxiety disorders (especially Social Phobia), Mental Retardation, hospitalization, or extreme psychosocial stressors may be associated with the disorder.

Immigrant children who are unfamiliar with or uncomfortable in the official language of their new host country may refuse to speak to strangers in their new environment (which is not considered selective mutism).

Selective Mutism is apparently rare and is found in fewer than 1% of individuals seen in mental health settings. Selective Mutism is slightly more common in females than in males.

Specific Symptoms of Selective Mutism

A. There is a consistent failure to speak in specific social situations (in which there is an expectation for speaking, e.g., in class at school), despite speaking in other situations.

B. The problem interferes with educational or occupational achievement or with social communication. In other words, the person is failing in school (or being held back), can’t move ahead in their job, or can’t create strong social relationships with friends or significant others.

C. The duration of the disturbance is at least 1 month (not limited to the first month of school).

D. The failure to speak is not due to a lack of knowledge of, or comfort with, the spoken language required in the social situation. (People who have difficulty speaking the language because they simply don’t know it wouldn’t qualify for this disorder.)

E. The disturbance is not better accounted for by a Communication Disorder (e.g., Stuttering) and does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder.